EXAM #2: THE DIABETIC FOOT Flashcards Preview

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Flashcards in EXAM #2: THE DIABETIC FOOT Deck (27):
1

What are the signs of PVD in the DM patient?

1) Claudication
2) Rest pain
3) Atrophic, shiney skin
4) Diminished hair growth
5) Dependent rubor
6) Pallor on elevation

2

How is the ABI determined?

Lower extremity systolic/ Brachial a. systolic pressure

3

What is a normal ABI?

Greater than 0.9

4

What ABI is indicative of severe obstruction?

0.5 or less

5

What can lead to abnormally elevated ABIs in DM patients?

Arterial calcification

6

What is the normal doppler waveform?

Triphasic

7

How does the doppler waveform change with worsening PVD?

Waves are lost; with severe disease the waveform is monophasic with loss of peak height

8

What does transcutaneous oxygen pressure measure? Why is this important?

Partial oxygen tension on the skin surface

*Provides important information about healing potential

9

If a patient has an abnormal non-invasive exam for PVD, what should you do?

Invasive arteriogram

10

What is Charcot Arthropathy?

Neurogenic arthropathy i.e. a progressive degeneration of a weight bearing joint; marked by:
- bony destruction
- bone resorption
- eventual deformity.

11

What are the three stages of Charcot Arthropathy?

Stage 1= Developmental (acute destructive)
- Swelling
- Fracture
Stage 2= Coalescence
- Healing begins
Stage 3= Reconstruction/ remodeling

12

How is Charcot Arthropathy treated?

1) Non-weight bearing (take precautions in opposite limb)
2) Cast/ immobilization
3) Serial x-rays
4) Address blood glucose and HbA1c

13

Where is the most common location for Charcot Arthropathy?

Midfoot

14

What is the physiologic basis for a chronic wound?

- Increased proteases and MMPs
- Decreased growth factors

15

What is a Grade 0 wound?

No evidence of ulcer of infection

16

What is a Grade 1 wound?

Superficial ulceration

17

What is a Grade 2 wound?

Deep ulcer that may expose tendon

18

What is a Grade 3 wound?

Deep ulceration with visible bone

19

What is a Grade 4 wound?

Gangrene of the forefoot

20

What is a Grade 5 wound?

Gangrene of the entire foot

21

What do you need to keep in mind about DM patients and infections of ulcers?

Do not present with classic sx. of infection

22

If a patient has an open ulcer, what should you do?

Take a deep swab or deep tissue culture

23

If a patient has a possible bone infection, what should you do?

Bone biopsy with histopathology and culture/sensitivity

24

What is the first image that should be obtained in possible osteomyelitis?

Plain x-rays

*Will show area of radiolucency

25

What is a Tc-99m scan? What does it evaluate for?

Standard bone scan that looks at bone turnover

26

What is the drawback to a Tc-99m scan?

Sensitive but not specific

27

What two bone scans can differentiate between acute osteomyelitis and Charcot Joint?

1) Indium
2) Ceretec

*Both will be positive in acute osteomyelitis and negative in Charcot Joint"